STRENGTHENING

YOUR PELVIC FLOOR

What is your pelvic floor and why does it matter?
Your pelvic floor is a group of ligaments and muscles that act as a sling to keep your pelvic organs (your
uterus, bladder, and bowels) in place and functioning correctly. Your pelvic floor generally does really great
at its job. However, there are some things that can work to weaken your pelvic floor, leading to problems
like prolapse and urinary incontinence. Things that can contribute to pelvic floor weakening include having a
family history of weak pelvic floor muscles, being pregnant (your mode of delivery does not matter for this),
older age, smoking, having a connective tissue disorder, and having a history of increased intra-abdominal
pressure (like from being overweight, constipated, or having a chronic cough, for example).

What can you do to strengthen your pelvic floor?

There are a number of things that you can do to help prevent pelvic prolapse or incontinence. For one,
living a healthy lifestyle can help keep your entire body well, including your pelvic floor. Be sure to address
any problems like constipation or chronic coughs.  Losing extra weight can help relieve pressure off your
pelvic floor also.

Working with a physical floor therapist who specializes in the pelvic floor can be extremely helpful for most
people, especially if you have been pregnant, given birth, or have other factors that put you at risk - even if
you do not yet have dysfunction. This specialist can give you personalized tips on strengthening your
pelvis, as well as feedback on how your pelvis is aligned and functioning. It may also help to get someone's
feedback during a vaginal exam to ensure that you are using the correct muscles during tightening. This
feedback can sometimes be in the form of a biofeedback machine, which has electrical sensors to read the
tone in your pelvis during muscle contractions and at rest.

Physical activity can be helpful to tone and strengthen your entire body, help lose extra weight, and
improve your pelvic floor too. Swimming or yoga are especially good at focusing on your pelvic area while
also working the rest of your body. Another way to help strengthen your pelvic area is through pelvic tilts.

Pelvic floor muscle training (commonly called kegels) is an additional way to tone your pelvic muscles and 
help prevent dysfunction. If done correctly, kegels should feel like you're lifting your vaginal canal up
toward your torso, not down or out (see below). You can even visualize your pelvic floor like an elevator,
rising up. If you very recently gave birth, it may not feel like you're accomplishing much, or you may feel
very tired by these exercises. That's OK! The effort you're putting in really is working toward a larger goal. 

Kegel Exercises Pelvic Tilts

Isolate the muscles of the pelvic floor. To do this, You can do pelvic tilts in a standing or hands-
squeeze the muscles that you would use to stop and-knees position. Make sure you breath slowly
your urine stream (but don't routinely do kegels throughout these exercises. In either position, do
while urinating!). As much as you can, relax your at least 5 cycles of pelvic tilts throughout the day.
buttocks, legs, and abdominal muscles. In standing: Stand straight but relaxed with your
While engaging only your pelvic floor, tighten back against a wall. Tilt your pelvis to flatten your
these muscles as hard as you can for 10 seconds. lower back against the wall. Release your pelvis,
Then release these muscles very slowly while as you were at rest. Repeat this 5-10 times.
maintaining as much control as you can. If you In hands-and-knees: This is the cat/cow pose in
can, try to even get an even more relaxed tone yoga. Start in a "table-like" position with your
than when you started. back straight. Tilt your pelvis so your lower back
Repeat this 10 times. gets arched up and hollowed. Then return to the
Aim for 5-10 cycles of these per day. flat position. Repeat 5-10 times.

References
Jordan, R. G., Farley, C. L., & Grace, K. T. (2019). Prenatal and postnatal care: A woman-centered approach (2nd ed.). Hoboken, NJ: Wiley.
King, T., Brucker, M., Fahey, J., Kriebs, J., Gegor, C., & Varney, H. (2015). Varney's midwifery (5th ed.). Sudbury, MA: Jones & Bartlett Learning.
Lim, R. (2001). After the baby's birth: A woman's way to wellness: A complete guide for postpartum women (2nd edition). [PDF version].
Updated: July 2019